Case Study: Severe Depression

Introduction
US Hispanics form the largest minority group in the country. Studies reveal that they face inconsistencies in the recognition and treatment of major depression (Roberto et al., 2005). Severe depression is the mental problem that is commonly diagnosed by primary care physicians. Moreover, the risk of severe depression is high among US-born Mexican Americans (Ring & Marquis, 1991). However, further studies indicate that Mexican immigrants have a significantly lower rate of severe depression compared to US-born Mexican Americans. The reason for this observation is that the immigrants experience less deprivation than US-born Hispanics. Likewise, according to Burnam, Hough, Escobar et al. (1987), they maintain a stronger family alignment which protects them from depression. This paper considers the case of a 32-year-old Hispanic American male who with severe depression and the treatment options available. The decision alternatives are considered to select the best option with the least exposure.

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Decision Point One
Selected Decision
Begin Zoloft 25 mg orally daily
Reason for Selection
Zoloft and Prozac are some of the most powerful prescriptions utilized to treat depression and other mental issues (Montgomery & Asberg, 1979). Zoloft is sertraline hydrochloride and is a good recommendation since it is linked with improving sleep, energy, and appetite (Stahl, 2014b). The 32-year-old Hispanic American male in this case suffers from insomnia, has lost interest in physical activities leading to gaining weight, avoiding socializing with others, and back pains. Zoloft also can aid with losing weight which this client also required having gained 15 pounds in the last 2 months. Prozac is attributed to many severe side effects hence Zoloft was the best option for this client.
Expected Results
It is possible to tell whether the drug is working within the first two weeks. After one to two weeks, there sleep, energy, and appetite are expected to improve. By the time the patient returns for checkup after four weeks, he should report reduced insomnia. The level of concentration and interest in physical activities also improves. It is also expected that the patient will engage in social activities like interacting with friends and eye contact in conversations.
Differences between Expected Results and Actual Results
While the patient reported a decrease of 25% in the symptoms, the actual results also showed that the client had a new onset of erectile dysfunction (Gaboda et al., 2014). This effect was not expected as the medication was being administered.
Decision Point Two
Selected Decision
Add an augmenting agent such as Wellbutrin IR 150 mg in morning
Reason for Selection
Wellbutrin commonly known as bupropion is also prescribed by doctors as an antidepressant drug. Unlike Zoloft and Prozac which are selective-serotonin reuptake inhibitors (SSRIs), this drug is found in the aminoketone class of drugs used to treat depression. It controls the levels and activity of the neurotransmitters but the way it treats depression is not known.
Expected Results
Being an augmenting agent, Wellbutrin IR is expected to decrease depression and reduce the onset of erectile dysfunction. Being chemically unrelated, Zoloft and Wellbutrin will work together to decrease depression and hence the collective impact should be bigger than when the drugs are used singly.
Differences between Expected Results and Actual Results
Prescribing Wellbutrin was to reduce depression as well as erection dysfunction which had been brought by Zoloft. It turns out that erectile dysfunction has declined while undesired jittery and nervous crept in. Feelings of jittery and nervousness are major side-effects of Wellbutrin.
Decision Point Three
Selected Decision
Change Wellbutrin to XL 150 mg orally in AM
Reason for Selection
Feelings of jittery and at times nervousness are the only problems that the patients has with the current therapy. The alteration of Wellbutrin to XL would not be appropriate since it could be the case that the client only experienced these side effects because he had not developed tolerance to the medication. It is known that developing tolerance for Wellbutrin can take an extremely long time.
Expected Results
The main reason why the doctor proposes is that he wants to ensure continued reduction in the rate of depression. Feelings of jitteriness is most likely attributed to immediate release of Wellbutrin (Kroenke, Spitzer & Williams, 2001). Thus, changing Wellbutrin to an extended release formulation like XL would do abate feelings of jitteriness and nervousness.
Differences between Expected Results and Actual Results
The decision seems appropriate and fits in the standard way of dealing with side effects of therapy prescribed to a patient. In medicine, a drug can be modified in a way so that it can handle the side-effects rather than introducing another drug altogether. Introducing a new drug has the risk of presenting new side effects altogether.
Impact of Ethical Considerations on Treatment Plan
Drugs administered for depression treatment like Zoloft and Wellbutrin have many complications including feeling of jittery and nervousness and erectile dysfunction. Others even cause patients to have suicidal tendencies. Based on the doctor’s assessment, some drugs may not be used especially those that induce suicidal inclinations as this patient avoids other people and that makes it risky (Hoppe, Leon & Realini, 1989). Furthermore, the doctor needs to inform the patient of the possible side effects of the drug being administered.

References


1. Burnam, M., Hough, R., Escobar, J, et al. (1987). Six-month prevalence of specific psychiatric disorders among Mexican Americans and non-Hispanic whites in Los Angeles. Arch Gen Psychiatry; 44, 687–694.
2. Gaboda, D., Lucas, J., Siegel, M., Kalay, E., and Crystal, S. (2014). No longer undertreated? Depression diagnosis and antidepressant therapy in elderly long?stay nursing home residents, 1999 to 2007. Journal of the American Geriatrics Society, 59(4), 673-680.
3. Hoppe, S., Leon, R. and Realini, J. (1989). Depression and anxiety among Mexican Americans in a family health center. Soc Psychiatry Psychiatr Epidemiol, 24, 63– 68.
4. Kroenke, K., Spitzer, R., Williams, J. (2001). The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med, 16, 606 –613.
5. Montgomery, S. A. and Asberg, M. (1979). A new depression scale designed to be sensitive to change. British Journal of Psychiatry, 134, 382-389.
6. Ring, J. and Marquis, P. (1991). Depression in a Latino immigrant medical population. Am J Orthopsychiatry, 61, 298 –302. 7. Roberto, L., Amar, K. D., César, A., Myrna, M. W. and Mark, O. (2005).Depression in US Hispanics: Diagnostic and Management Considerations in Family Practice. Journal of the American Board of Family Medicine, 18(4), 282-296.
8. Stahl, S. M. (2014b). The prescriber’s guide (5th ed.). New York, NY: Cambridge University Press.

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